Abstract The economic and health impact of medication nonadherence is staggering. Not taking medication places patients at a 5.4 times increased risk of hospitalization, re-hospitalization, or premature death. Patients with diabetes are at a 2.5 times increased risk of hospitalization. Not surprising, more than 40 percent of nursing home admissions are directly linked to medication non-adherence (1). The rate of nonadherence is expected to increase as the burden of chronic disease increases. Medicare patients suffer disproportionately as they are challenged by multiple chronic conditions, multiple medication prescriptions, changing medication regimens, limited dexterity, and limited, fixed monthly income. The primary problem is that once patients go into their homes, Caregivers and or Care Managers (often a RN provided by the patient?s insurance company) do not know when a medication adherence problem develops. Realizing the severity of this problem, several companies have attempted to develop home-based solutions however based on our research and field experience we believe these solutions are overly complex and too costly. We believe that our experience with patients in a care management model gives us a tremendous advantage: our registered nurse (RN) co-founder of Green Apple Technologies has had over 10,000 telephonic care management conversations with Medicare Advantage patients who have chronic conditions. The interactions between care manager and patient often focus on trying to solve the burden of medication non-adherence in the home. With the needs of these patients in mind, Green Apple Technologies was formed in 2015 to work on a practical solution. To date we have developed a primitive proof-of -concept prototype to validate our medication imaging software in a 28-bin smart medication organizer, E.M.E.T. ? (Every Med Every Time). We are seeking Phase I funding to obtain the input of our Medicare test population by conducting two User- Centered design meetings. After analysis of the feedback received in the first meeting, we will re-design our device to enhance usability. We will then obtain final input from the users at meeting two. After researching the current solutions on the market, we believe that this critical user input step has been missed. We are submitting this SBIR Phase I proposal to achieve two specific aims: Aim (1) To engage our test population to assist in the design of a medication adherence device that is highly usable as defined by the Usability of Devices scale. Aim (2) Measure and estimate the accuracy of our medication imaging system to accurately detect changes in medication routine.